CMS-P-0015A Physical_Measures

2021 MCBS Community Questionnaire

Variable Name

MR Screen Name Question Type

PXQ- PHYSICAL MEASURES

Question Text/Description

Code List

Routing

PHYSICAL MEASURES QUESTIONNAIRE SPECIFICATIONS
CRITERIA
INTTYPE=C001, C002, C003, C004, C005, C006, C010
SPALIVE=1
SEASON=FALL, SUMMER
SPPROXY=SP
Other: N/A
PLACEMENT
If INTTYPE in(C003), administer after HFQ.
If INTTYPE in(C001, C002, C004, C005, C006, C010), administer after CPQ.
IF R IS IN A WHEELCHAIR OR CANNOT STAND, SELECT "R CANNOT PARTICIPATE" WITHOUT READING
TEXT BELOW.
Now I am going to ask you to do a few simple activities. Researchers are
interested in how performance on these activities relates to some of the other factors I
have asked you about in the interview.
PHYSINTRO

PHYSINTRO

no entry

(01) CONTINUE
(02) R CANNOT PARTICIPATE (IN WHEELCHAIR,
I will ask you to do these activities: height and weight measurements, a balance test, a walking test, and a standing CAN’T STAND)
test.

(01) HGTINTRO
(02) GRPSTART

My primary concern is for your safety, so I will ask you if you feel it would be safe for
you to complete each activity. I will describe these measurements and ask if you would feel comfortable and safe
completing each of the measurements. We will then complete the measurements one after the other.
Let's start by measuring your height.

HGTINTRO

HGTINTRO

code one

I will ask you to stand up straight against the wall with your feet together. Then, I will mark your height on the wall
using a sticky note and ask you to step away. I will then measure from the sticky note to the floor.

(01) CONTINUE
(02) R CANNOT OR WILL NOT PARTICIPATE

(01) HGTMEASU
(02) HGTREASN

(01) continuous answer
(996) TEST COULD NOT BE COMPLETED

(01) WGTINTRO
(996) HGTREASN

(01) EQUIPMENT PROBLEM
(02) NO SUITABLE SPACE TO CONDUCT THE
MEASURE
(03) R UNABLE TO UNDERSTAND INSTRUCTIONS
(04) NOT ATTEMPTED, FI FELT IT WAS UNSAFE
(05) NOT ATTEMPTED, R FELT UNSAFE
(06) ATTEMPTED, UNABLE TO DO
(91) OTHER
(-8) DON'T KNOW
(-9) REFUSED

(01) - (06), (-8), (-9) WGTINTRO
(91) HGTREAOS

(01) Continuous answer

WGTINTRO

Is there any reason why you feel you cannot participate?
[IF R REFUSES TO ATTEMPT THE MEASURE, SELECT R CANNOT OR WILL NOT PARTICIATE]
RECORD HEIGHT TO THE NEAREST HALF-INCH.
HGTMEASU

HGTMEASU

verbatim text
[HEIGHT MUST BE RECORDED IN INCHES]

CODE THE PRIMARY REASON WHY THE TEST COULD NOT BE COMPLETED.
HGTREASN

HGTREASN

code one
[IF THE RESPONDENT REFUSED TO ATTEMPT THE MEASURE, SELECT "REFUSED."]

HGTREAOS

HGTREAOS

verbatim text

WHAT IS THE PRIMARY REASON THE RESPONDENT CANNOT OR WILL NOT PARTICIPATE IN THIS
MEASURE?
Now, we will measure your weight.

WGTINTRO

WGTINTRO

code one

I will ask you to stand on the scale and stand still. Once I have recorded the weight, I will ask you to step off of the
scale.

(01) CONTINUE
(02) R CANNOT OR WILL NOT PARTICIPATE

(01) WGTMEASU
(02) WGTREASN

Is there any reason why you feel you cannot participate?
[IF R REFUSES TO ATTEMPT THE MEASURE, SELECT R CANNOT OR WILL NOT PARTICIATE]

WGTMEASU

WGTMEASU

verbatim text

RECORD WEIGHT TO THE NEAREST TENTH OF A POUND

(01) continuous answer
(02) R OVER SCALE MAXIMUM
(996) TEST COULD NOT BE COMPLETED

(01) BALINTRO
(02) BALINTRO
(996) WGTREASN

Page 1 of 8

2021 MCBS Community Questionnaire

Variable Name

MR Screen Name Question Type

PXQ- PHYSICAL MEASURES

Question Text/Description

Code List

Routing

(01) - (06), (-8), (-9) BALINTRO
(91) WGTEXCLD

BALINTRO

WGTREASN

WGTREASN

code one

CODE THE PRIMARY REASON WHY THE TEST COULD NOT BE COMPLETED.

(01) EQUIPMENT PROBLEM
(02) NO SUITABLE SPACE TO CONDUCT THE
MEASURE
(03) R UNABLE TO UNDERSTAND INSTRUCTIONS
(04) NOT ATTEMPTED, FI FELT IT WAS UNSAFE
(05) NOT ATTEMPTED, R FELT UNSAFE
(06) ATTEMPTED, UNABLE TO DO
(91) OTHER
(-8) DON'T KNOW
(-9) REFUSED

WGTEXCLD

WGTEXCLD

verbatim text

WHAT IS THE PRIMARY REASON THE RESPONDENT CANNOT OR WILLNOT PARTICIPATE IN THIS
MEASURE?

(01) Continuous answer

BALINTRO

BALINTRO

no entry

Next I am going to ask you to do a few simple activities for me, starting with a balance measure. Let me first
demonstrate this measure. After I demonstrate the measure, please tell me if you cannot do a particular movement (01) CONTINUE
or if you feel it would be unsafe to try and do it.
(02) R CANNOT OR WILL NOT PARTICIPATE

(01) BALPOS1
(02) BALREAS1

[IF R REFUSES TO ATTEMPT THE MEASURE, SELECT R CANNOT OR WILL NOT PARTICIATE]
SHOW CARD PX1
DEMONSTRATE FIRST POSITION WHILE EXPLAINING POSITION
STAND WITH FEET TOGETHER, SIDE-BY-SIDE FOR 10 SECONDS
TRY NOT TO MOVE YOUR FEET
TRY TO HOLD THIS POSITION UNTIL I TELL YOU TO STOP
ASK R TO STAND IN FIRST POSITION
ONCE R IS IN POSITION, SAY ‘BEGIN’ AND START TIMING
BALPOS1

BALPOS1

code one
TIME THE FIRST POSITION
PUSH ‘START’ BUTTON WHEN YOU SAY ‘BEGIN’
PUSH ‘STOP/RESET’ BUTTON AND SAY ‘STOP’ AFTER 10 SECONDS, OR
PUSH ‘STOP/RESET’ BUTTON IF RESPONDENT STEPS OUT OF THE POSITION BEFORE 10 SECONDS

(01) NUMBER OF SECONDS HELD: _____
[996] TEST COULD NOT BE COMPLETED

(01) = 10 seconds, go to BALPOS2;
(01) ^=10 seconds, go to WALINTRO;
(996) BALREAS1

(01)-(06), (-8), (-9) WALINTRO
(91) BALREOS1

WALINTRO

WHEN R IS IN FIRST POSITION:
Are you ready?
WHEN R IS READY, PUSH ‘START’ AND SAY:
Begin

BALREAS1

BALREAS1

code one

CODE THE PRIMARY REASON WHY THE TEST COULD NOT BE COMPLETED

(01) EQUIPMENT PROBLEM
(02) NO SUITABLE SPACE TO CONDUCT THE
MEASURE
(03) R UNABLE TO UNDERSTAND INSTRUCTIONS
(04) NOT ATTEMPTED, FI FELT IT WAS UNSAFE
(05) NOT ATTEMPTED, R FELT UNSAFE
(06) ATTEMPTED, UNABLE TO DO
(91) OTHER
(-8) DON'T KNOW
(-9) REFUSED

BALREOS1

BALREOS1

verbatim text

OTHER (SPECIFY)

(01) [Continuous answer]

Page 2 of 8

2021 MCBS Community Questionnaire

Variable Name

MR Screen Name Question Type

PXQ- PHYSICAL MEASURES

Question Text/Description

Code List

Routing

(01) NUMBER OF SECONDS HELD: _____
[996] TEST COULD NOT BE COMPLETED

(01) = 10 seconds, go to BALPOS3;
(01) ^= 10, go to WALINTRO
(996) BALREAS2

(01)-(06), (-8), (-9) WALINTRO
(91) BALREOS2

SHOW CARD PX2
DEMONSTRATE SECOND POSITION WHILE EXPLAINING POSITION
STAND WITH THE HEEL OF ONE FOOT TOUCHING THE SIDE OF THE BIG TOE OF THE OTHER FOOT
FOR 10 SECONDS
TRY NOT TO MOVE YOUR FEET
TRY TO HOLD THIS POSITION UNTIL I TELL YOU TO STOP
ASK R TO STAND IN SECOND POSITION
BALPOS2

BALPOS2

code one

ONCE R IS IN POSITION, SAY ‘BEGIN’ AND START TIMING
TIME THE SECOND POSITION
PUSH ‘START’ BUTTON WHEN YOU SAY ‘BEGIN’
PUSH ‘STOP/RESET’ BUTTON AND SAY ‘STOP’ AFTER 10 SECONDS, OR
PUSH ‘STOP/RESET’ BUTTON IF RESPONDENT STEPS OUT OF THE POSITION BEFORE 10 SECONDS
WHEN R IS IN SECOND POSITION:
Are you ready?
WHEN R IS READY, PUSH ‘START’ AND SAY:
Begin

BALREAS2

BALREAS2

code one

CODE THE PRIMARY REASON WHY THE TEST COULD NOT BE COMPLETED

(01) EQUIPMENT PROBLEM
(02) NO SUITABLE SPACE TO CONDUCT THE
MEASURE
(03) R UNABLE TO UNDERSTAND INSTRUCTIONS
(04) NOT ATTEMPTED, FI FELT IT WAS UNSAFE
(05) NOT ATTEMPTED, R FELT UNSAFE
(06) ATTEMPTED, UNABLE TO DO
(91) OTHER
(-8) DON'T KNOW
(-9) REFUSED

BALREOS2

BALREOS2

verbatim text

OTHER (SPECIFY)

(01) [Continuous answer]

WALINTRO

(01) NUMBER OF SECONDS HELD: _____
[996] TEST COULD NOT BE COMPLETED

(01) go to WALINTRO
(996) BALREAS3

(01)-(06), (-8), (-9) WALINTRO
(91) BALREOS3

WALINTRO

SHOW CARD PX3
DEMONSTRATE THIRD POSITION WHILE EXPLAINING POSITION
STAND WITH THE HEEL OF ONE FOOT IN FRONT OF AND TOUCHING THE TOES OF THE OTHER FOOT
FOR 10 SECONDS
TRY NOT TO MOVE YOUR FEET
TRY TO HOLD THIS POSITION UNTIL I TELL YOU TO STOP
ASK R TO STAND IN THIRD POSITION
BALPOS3

BALPOS3

code one

ONCE R IS IN POSITION, SAY ‘BEGIN’ AND START TIMING
TIME THE THIRD POSITION
PUSH ‘START’ BUTTON WHEN YOU SAY ‘BEGIN’
PUSH ‘STOP/RESET’ BUTTON AND SAY ‘STOP’ AFTER 10 SECONDS, OR
PUSH ‘STOP/RESET’ BUTTON IF RESPONDENT STEPS OUT OF THE POSITION BEFORE 10 SECONDS
WHEN R IS IN THIRD POSITION:
Are you ready?
WHEN R IS READY, PUSH ‘START’ AND SAY:
Begin

BALREAS3

BALREAS3

code one

CODE THE PRIMARY REASON WHY THE TEST COULD NOT BE COMPLETED

(01) EQUIPMENT PROBLEM
(02) NO SUITABLE SPACE TO CONDUCT THE
MEASURE
(03) R UNABLE TO UNDERSTAND INSTRUCTIONS
(04) NOT ATTEMPTED, FI FELT IT WAS UNSAFE
(05) NOT ATTEMPTED, R FELT UNSAFE
(06) ATTEMPTED, UNABLE TO DO
(91) OTHER
(-8) DON'T KNOW
(-9) REFUSED

BALREOS3

BALREOS3

verbatim text

OTHER (SPECIFY)

(01) [Continuous answer]

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2021 MCBS Community Questionnaire

Variable Name

MR Screen Name Question Type

PXQ- PHYSICAL MEASURES

Question Text/Description

Code List

Routing

(01) CONTINUE
(02) R CANNOT OR WILL NOT PARTICIPATE

(01) WALKTIM1
(02) WALKREAS1

(01) ABLE TO DO (SPECIFY SECONDS): ______
[996] TEST COULD NOT BE COMPLETED

(01) WALKTIM2
(996) WALKREAS1

(01)-(06), (-8), (-9) CSINTRO
(91) WALKOS1

Now I am going to observe how you normally walk. If you use a cane or other walking aid and you feel you need it to
walk a short distance, then you may use it. First, let me demonstrate this measure.
WALINTRO

WALINTRO

no entry

After I demonstrate the measure, please tell me if you cannot do a particular movement or if you feel it would be
unsafe to try and do it.
[IF R REFUSES TO ATTEMPT THE MEASURE, SELECT R CANNOT OR WILL NOT PARTICIATE]
USE PRE-CUT STRING TO MEASURE DISTANCE ON THE FLOOR
DEMONSTRATE THE WALK WHILE PROVIDING INSTRUCTIONS
STAND WITH TOES TOUCHING THE BEGINNING OF THE STRING
START WALKING WHEN I SAY BEGIN
WALK AT YOUR USUAL PACE
WALK PAST THE END OF THE STRING BEFORE YOU STOP

WALKTIM1

WALKTIM1

code one

ALLOW R TO USE HIS/HER WALKING AID (CANE OR WALKER)
ASK R TO STAND AT BEGINNING OF STRING
When I say “Begin” you may start walking.
PUSH ‘START’ AND SAY:
‘Begin’
PUSH ‘STOP/RESET’ WHEN ONE OF R’S FEET IS COMPLETELY ACROSS THE OTHER END OF THE STRING

WALKREAS1

WALKREAS1

code one

CODE THE PRIMARY REASON WHY THE TEST COULD NOT BE COMPLETED

(01) EQUIPMENT PROBLEM
(02) NO SUITABLE SPACE TO CONDUCT THE
MEASURE
(03) R UNABLE TO UNDERSTAND INSTRUCTIONS
(04) NOT ATTEMPTED, FI FELT IT WAS UNSAFE
(05) NOT ATTEMPTED, R FELT UNSAFE
(06) ATTEMPTED, UNABLE TO DO
(91) OTHER
(-8) DON'T KNOW
(-9) REFUSED

WALKOS1

WALKOS1

verbatim text

OTHER (SPECIFY)

(01) [Continuous answer]

CSINTRO

(01) ABLE TO DO (SPECIFY SECONDS): ______
[996] TEST COULD NOT BE COMPLETED

(01) WALKPROB
(996) WALKREAS2

(01)-(06), (-8), (-9) CSINTRO
(91) WALKOS2

ASK RESPONDENT TO REPEAT WALK, FROM THE END OF THE STRING BACK TO THE BEGINNING OF THE
STRING
When I say “Begin” you may start walking.
WALKTIM2

WALKTIM2

code one
PUSH ‘START/STOP’ AND SAY:
‘Begin’
PUSH ‘STOP/RESET’ WHEN ONE OF R’S FEET IS COMPLETELY ACROSS THE OTHER END OF THE STRING

WALKREAS2

WALKREAS2

code one

CODE THE PRIMARY REASON WHY THE TEST COULD NOT BE COMPLETED

(01) EQUIPMENT PROBLEM
(02) NO SUITABLE SPACE TO CONDUCT THE
MEASURE
(03) R UNABLE TO UNDERSTAND INSTRUCTIONS
(04) NOT ATTEMPTED, FI FELT IT WAS UNSAFE
(05) NOT ATTEMPTED, R FELT UNSAFE
(06) ATTEMPTED, UNABLE TO DO
(91) OTHER
(-8) DON'T KNOW
(-9) REFUSED

WALKOS2

WALKOS2

verbatim text

OTHER (SPECIFY)

(01) [Continuous answer]

CSINTRO

RECORD YOUR OBSERVATIONS OF THE R'S MEASURE. CHECK ALL THAT APPLY.

(01) R WALKED UNSTEADILY
(02) R LIMPED, SHUFFLED OR DRAGGED A LEG
(03) R USED A CANE
(04) R USED WALKER
(05) R STATED IT’S PAINFUL
(06) NOTHING APPLIES

CSINTRO

WALKPROB

WALKPROB

code all

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2021 MCBS Community Questionnaire

Variable Name

CSINTRO

MR Screen Name Question Type

CSINTRO

no entry

PXQ- PHYSICAL MEASURES

Question Text/Description

Code List

Now I am going to ask you to stand up from a chair without using your arms. First, let me demonstrate this measure.
After I demonstrate the measure, please tell me if you cannot do this movement or if you feel it would be unsafe to
(01) CONTINUE
try.
(02) R CANNOT OR WILL NOT PARTICIPATE

Routing
(01) SNGLCS
(02) SNGLREAS

[IF R REFUSES TO ATTEMPT THE MEASURE, SELECT R CANNOT OR WILL NOT PARTICIATE]

SNGLCS

SNGLCS

code one

DEMONSTRATE CHAIR STAND WHILE PROVIDING INSTRUCTIONS
SIT IN CHAIR WITH YOUR FEET ON THE FLOOR. SIT SO THAT YOU CAN PLACE THE WIDTH OF YOUR
HANDS BETWEEN THE CHAIR AND YOUR KNEES.
FOLD YOUR ARMS ACROSS YOUR CHEST
STAND UP, KEEPING YOUR ARMS FOLDED ACROSS YOUR CHEST

(01) R STOOD WITHOUT USING ARMS
[996] TEST COULD NOT BE COMPLETED

(01) CSINTRO2
(03) SNGLREAS

(01)-(06), (-8), (-9) BOX PXEND
(91) SNGLCSOS

When I say ‘Begin’ you may stand up straight from the chair.

SNGLREAS

SNGLREAS

code one

CODE THE PRIMARY REASON WHY THE TEST COULD NOT BE COMPLETED

(01) EQUIPMENT PROBLEM
(02) NO SUITABLE SPACE TO CONDUCT THE
MEASURE
(03) R UNABLE TO UNDERSTAND INSTRUCTIONS
(04) NOT ATTEMPTED, FI FELT IT WAS UNSAFE
(05) NOT ATTEMPTED, R FELT UNSAFE
(06) ATTEMPTED, UNABLE TO DO
(91) OTHER
(-8) DON'T KNOW
(-9) REFUSED

SNGLCSOS

SNGLCSOS

verbatim text

OTHER (SPECIFY)

(01) [Continuous answer]

BOX PXEND

no entry

Now I'm going to ask you to stand up and sit down as quickly as you can five times, keeping your arms folded
across your chest. I'm going to demonstrate one for you.

(01) CONTINUE

RPTDCS

(01) TIME TO COMPLETE FIVE STANDS (SPECIFY
SECONDS): ______
[996] TEST COULD NOT BE COMPLETED

(01) BOX PXEND
(996) CSREAS

(01)-(06), (-8), (-9) BOX PXEND
(91) CSOS

CSINTRO2

CSINTRO2

DEMONSTRATE 1 CHAIR STAND WHILE PROVIDING INSTRUCTIONS
SIT IN CHAIR WITH YOUR FEET ON THE FLOOR
FOLD YOUR ARMS ACROSS YOUR CHEST
STAND UP AND SIT DOWN ONCE
TELL R TO REPEAT THAT 4 MORE TIMES
When I say “Begin” you may stand up.
RPTDCS

RPTDCS

code one
PUSH ‘START’ AND SAY ‘Begin’
COUNT OUT LOUD AS RESPONDENT ARISES EACH TIME
PUSH ‘STOP/RESET’ WHEN R HAS COMPLETELY STOOD UP FROM THE CHAIR FOR THE 5TH TIME
STOP THE EXERCISE EARLY IF R CANNOT RISE WITHOUT USING ARMS, R IS TOO TIRED TO
CONTINUE, OR R IS UNABLE TO COMPLETE AFTER 1 MINUTE

CSREAS

CSREAS

code one

CODE THE PRIMARY REASON WHY THE TEST COULD NOT BE COMPLETED

(01) EQUIPMENT PROBLEM
(02) NO SUITABLE SPACE TO CONDUCT THE
MEASURE
(03) R UNABLE TO UNDERSTAND INSTRUCTIONS
(04) NOT ATTEMPTED, FI FELT IT WAS UNSAFE
(05) NOT ATTEMPTED, R FELT UNSAFE
(06) ATTEMPTED, UNABLE TO DO
(91) OTHER
(-8) DON'T KNOW
(-9) REFUSED

CSOS

CSOS

verbatim text

OTHER (SPECIFY)

(01) [Continuous answer]

GRPSTART

GRPSTART

GRPSTART

code one

(01) CONTINUE
(02) R CANNOT PARTICIPATE (MISSING BOTH
HANDS)

(01) MSNGHAND
(02) BOX PXEND

(01) R IS MISSING RIGHT HAND
(02) R IS MISSING LEFT HAND
(03) CONTINUE

DOMNHAND

IF R IS MISSING BOTH OF THEIR HANDS, SELECT "(02) R CANNOT PARTICIPATE" WITHOUT READING
TEXT BELOW.
Now I would like to assess the strength of your hand in a gripping action.

MSNGHAND

MSNGHAND

code one

IF R IS OBVIOUSLY MISSING ONE HAND, SELECT WHICH HAND IS MISSING. IF R IS NOT OBVIOUSLY
MISSING A HAND, SELECT "CONTINUE"

Page 5 of 8

2021 MCBS Community Questionnaire

Variable Name

MR Screen Name Question Type

PXQ- PHYSICAL MEASURES

Question Text/Description

IF SP IS OBVIOUSLY MISSING A HAND OR ARM, SELECT THE REMAINING HAND AND DO NOT ASK.
OTHERWISE, ASK:
DOMNHAND

DOMNHAND

code one

Which is your dominant hand?
[If Needed: Which hand do you use to hold a pencil?]

Code List

(01) Right
(02) Left
(03) Both hands equally dominant
(-8) DON'T KNOW
(-9) REFUSED

Routing

GRPINTRO

Now we will measure your grip strength
We will use this machine [SHOW DYNAMOMETER] to measure how strong your hands are.
GRPINTRO

GRPINTRO

code one

You will squeeze the handle 2 times [per hand], one practice and one test trial, while your arm is at your side and
your elbow is bent like this [DEMONSTRATE 90 DEGREES].

(01) CONTINUE

(01) BOX PX1

(01) CONTINUE

(01) BOX PX2

The handle won’t move, but the machine will show how hard you squeezed. [PRESSRESET AND TEST, THEN
SQUEEZE TO DEMONSTRATE].
See? [SHOW RESPONDENT THE FORCE MEASUREMENT].

If MSNGHAND = 01 (RIGHT) go to LHANDPRC
Else, go to RHANDPRC

BOX PX1

SHOW CARD PX4
Let’s practice with your RIGHT hand.
Is there any reason why you feel you cannot participate with your right hand? The items on this card list some
examples of reasons why you should not participate.
IF RESPONDENT HAS ANY OF THE CONDITIONS LISTED ON SHOWCARD PX4 FOR THEIR RIGHT HAND,
SELECT CONTINUE WITHOUT COMPLETING THE PRACTICE TRIAL
RHANDPRC

RHANDPRC

no entry

When I say ‘squeeze,’ I want you to squeeze the handle hard, but not as hard as you can.
[If Needed: We are starting with the right hand, even if you are not right handed.]
[SUPPORT DYNAMOMETER DURING PRACTICE]
Ready? 3-2-1-squeeze. [HOLD FOR 3-4 SECONDS]
Stop.
[PRESS RESET AND TEST ON DYNAMOMETER BEFORE CONTINUING]

BOX PX2

If MSNGHAND = 02 (LEFT) go to RHANDTST
Else, go to LHANDPRC

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2021 MCBS Community Questionnaire

Variable Name

MR Screen Name Question Type

PXQ- PHYSICAL MEASURES

Question Text/Description

Code List

Routing

SHOW CARD PX4
Let’s practice with your LEFT hand.
Is there any reason why you feel you cannot participate with your left hand? The items on this card list some
examples of reasons why you should not participate.
IF RESPONDENT HAS ANY OF THE CONDITIONS LISTED ON SHOWCARD PX4 FOR THEIR LEFT HAND,
SELECT CONTINUE WITHOUT COMPLETING THE PRACTICE TRIAL
LHANDPRC

LHANDPRC

no entry

(01) CONTINUE
When I say ‘squeeze,’ I want you to squeeze the handle hard, but not as hard as you can.

(01) BOX PX3

[SUPPORT DYNAMOMETER DURING PRACTICE.]
Ready? 3-2-1-squeeze. [HOLD FOR 3-4 SECONDS]
Stop.
[PRESS RESET AND TEST ON DYNAMOMETER BEFORE CONTINUING]

If MSNGHAND = 01 (RIGHT) go to LHANDTST
Else, go to RHANTST

BOX PX3

IF RESPONDENT HAS ANY OF THE CONDITIONS LISTED ON SHOWCARD PX4 FOR THEIR RIGHT HAND,
SELECT "TEST COULD NOT BE COMPLETED" WITHOUT CONDUCTING THE TEST
Now we’re going to test your RIGHT hand. When I say ‘squeeze,’ this time I want you to squeeze the handle as
hard as you can.
RHANDTST

RHANDTST

code one

[SUPPORT DYNAMOMETER DURING TEST]

(01) continuous answer
(996) TEST COULD NOT BE COMPLETED

(01) BOX PX4
(996) RHDREASN

Ready? 3-2-1-squeeze! Harder, harder, harder! [HOLD FOR 3-4 SECONDS]
Stop.
[RECORD FORCE TO NEAREST TENTH OF A POUND]
[PRESS RESET AND TEST ON DYNAMOMETER]

If MSNGHAND = 02 (LEFT) go to BOX PXEND
Else, go to LHANDTST

BOX PX4

RHDREASN

RHDREASN

code one

REASON WHY CANNOT BE COMPLETED FOR RIGHT HAND

(01) EQUIPMENT PROBLEM
(02) NO SUITABLE SPACE TO CONDUCT THE
MEASURE
(03) R UNABLE TO UNDERSTAND INSTRUCTIONS
(04) NOT ATTEMPTED, FI FELT IT WAS UNSAFE
(01)-(07), (-8), (-9) BOX PX4
(05) NOT ATTEMPTED, R FELT UNSAFE
(91) RHDRSNOS
(06) NOT ATTEMPTED, R MET EXCLUSION CRITERIA
(07) ATTEMPTED, UNABLE TO DO
(91) OTHER
(-8) DON'T KNOW
(-9) REFUSED

RHDRSNOS

RHDRSNOS

verbatim text

OTHER (SPECIFY)

(01) [Continuous answer]

BOX PX4

Page 7 of 8

2021 MCBS Community Questionnaire

Variable Name

MR Screen Name Question Type

PXQ- PHYSICAL MEASURES

Question Text/Description

Code List

Routing

(01) continuous answer
(996) TEST COULD NOT BE COMPLETED

(01) BOX PXEND
(996) LHDREASN

IF RESPONDENT HAS ANY OF THE CONDITIONS LISTED ON SHOWCARD PX4 FOR THEIR LEFT HAND,
SELECT "TEST COULD NOT BE COMPLETED" WITHOUT CONDUCTING THE TEST AND TURN OFF THE
DYNAMOMETER.
Now we’re going to test your LEFT hand. When I say ‘squeeze,’ this time I want you to squeeze the handle as hard
as you can.
LHANDTST

LHANDTST

code one

[SUPPORT DYNAMOMETER DURING TEST]
Ready? 3-2-1-squeeze! Harder, harder, harder! [HOLD FOR 3-4 SECONDS]
Stop.
[RECORD FORCE TO NEAREST TENTH OF A POUND]
[TURN OFF THE DYNAMOMETER]

LHDREASN

LHDREASN

code one

REASON WHY CANNOT BE COMPLETED FOR LEFT HAND

(01) EQUIPMENT PROBLEM
(02) NO SUITABLE SPACE TO CONDUCT THE
MEASURE
(03) R UNABLE TO UNDERSTAND INSTRUCTIONS
(04) NOT ATTEMPTED, FI FELT IT WAS UNSAFE
(01)-(07), (-8), (-9) BOX PXEND
(05) NOT ATTEMPTED, R FELT UNSAFE
(91) LHDRSNOS
(06) NOT ATTEMPTED, R MET EXCLUSION CRITERIA
(07) ATTEMPTED, UNABLE TO DO
(91) OTHER
(-8) DON'T KNOW
(-9) REFUSED

LHDRSNOS

LHDRSNOS

verbatim text

OTHER (SPECIFY)

(01) [Continuous answer]

BOX PXEND

routing

IF SEASON=FALL, GO TO NAQ.
IF SEASON=SUMMER, GO TO IAQ.

BOX PXEND

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